Healthy Gut, Happy Brain with Gut Detective Pediatrician Kristin Struble MD

In this episode, Dr Kristin Struble and I talk about some common gut issues seen in babies, the gut brain connection and more.
Dr. Kristin Struble, a Tucson native and the youngest of six, achieved academic excellence at the University of Arizona. Graduating magna cum laude in nutrition and biochemistry, she earned top honors and two student awards for excellence in pediatrics. 

Dr. Struble's passion for nutrition didn't stop with her education; she authored a humorous children's book titled "How to Be a Poop Detective," focusing on diet and nutrition.

Completing her pediatric residency at Phoenix Children’s Hospital in 2001, Dr. Struble has consistently been recognized as a "Top Doc" by Phoenix Magazine and received multiple awards, including three from Arizona Foothills Magazine, "Best of the Valley" Pediatricians and one for Arizona Republic's "Best of the Desert". She also received a noteworthy nomination from Phoenix Business Journal's healthcare award.

Dr. Struble has had the honor of being a regular guest and author for local news stations, podcasts, and  publications like Forbes Magazine and the Washington Post, discussing her children's book and other medically relevant topics. She currently pursues certification in functional integrative medicine. Happily married to Stephen Chakmakian, DO, and a proud mother, Dr. Struble finds joy in family, friends, hiking, running, Peloton, and exploring new cuisines.
https://www.camelbackpediatrics.com/About-Us/Meet-the-Providers/Kristin-Struble,-M-D-,-F-A-A-P

Cover art by Charlotte Feldman
Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.

Transcript

0:06

Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin 0:35

Welcome back to The Kids Matter podcast, Is it true that all health stems from the gut? Today on this podcast, we're talking with Dr. Kristen Struble. Hi Kristen. She's a Phoenix based pediatrician with a focus on functional integrative medicine and a passion for nutrition that goes back to her days in biochemistry from her residency at Phoenix Children's Hospital to becoming a national voice on pediatric health. She's here to show us how to optimize our children's health from the inside out. So welcome Dr. Strubble. Thank you so much for joining me today.

Kristin Struble 1:11

thank you for having me. This is so fun. Thank

Alisa Minkin 1:14

It, it is fun. And once we start talking, we may not be able to stop. We

Kristin Struble 1:19

Yep.

Alisa Minkin 1:20

really, we.

Kristin Struble 1:21

imagine that's the case for

Alisa Minkin 1:22

Yes. I.

Kristin Struble 1:23

to you all day.

Alisa Minkin 1:24

Two pediatricians, and we not are just pediatricians, but we align a lot. We're both really, really passionate about helping parents raise truly healthy children with a focus on nutrition and other important healthy habits. So I wanna dive right in and ask you why do you call yourselves gut health detective? What is that?

Kristin Struble 1:45

Again, that stems from my days, I think, in undergrad where nutrition and biochemistry were very much aligned with kind of my, the evolution of my thought process. And then when I got into medical school, Andrew Weil, he, I consider him the father of integrative medicine, actually just started at the University of Arizona, giving lectures at our med school. And I, was able to listen to some of his lectures and it, I guess my passion even continued to grow from there. So I actually did an internship out here in UCSD with a professor who was at the forefront, I believe there, and got health medicine too. So just continuing into residency or into residency, pediatrics, nutrition prevention, at the beginning. I just fell in love with more of the gut focus. And when I started in practice I was telling you about, just even looking at formula and watching the effects on newborn babies and trying to look for pattern recognition and seeing just minor changes that you could make. Seeing how that it could not only change. Angry, irritable bowel from horrific to better and watching skin manifestations improve. So with that, I'm like, all disease begins in the gut. And Hippocrates, the father of, the father of traditional medicine or allopathic medicine, that all disease begin begins in the gut and four 60 ad and I truly believe that's the case.

Alisa Minkin 3:15

I did not realize that Is really very before his time because now this is such a super, super hot topic. I wanna start with the babies because you and I know as pediatricians we spend an inordinate amount of time dealing with baby gut issues, and so I wanna hear how you handle it. I've heard you speak before about talking about when a mother is breastfeeding about her diet and also about how that affects the baby.

Kristin Struble 3:42

So what I've noticed, again, pattern recognition is for years when moms are breastfeeding, I noticed that if they're big consumers of cow's milk in particular, not necessarily even dairy products, that it's not uncommon for those babies to develop sensitivities. Fussiness, right around three weeks of age, you have the perfect baby until around two weeks. And then all of a sudden you see this evolution of more fussy, mommy's having to hold them all the time. They're eating to self-soothe. So around three weeks of age, that's when it exponentially takes off. And so oftentimes have moms come in around three weeks just with their shoulders high or at their one month visit, just stressing. And you can see it. you go through those symptoms of silent reflux or colic or irritable bowel or angry bowel, and find out that know, you dive into mom's diet. And more oftentimes than not, they're big dairy consumers. So with that, modify their diet and they get better. So I'm gonna back up. What I recommend to my moms very strongly is that they limit their dairy. So they do dairy, light and in particular, avoid cow's milk because I don't know if you've noticed it, but many of my colleagues, even in my practice, we've noticed an increase in anodic or horrific stools, mucusy green, and then they evolve into bright red blood. And it seems like it has been worse than it's ever been. So to

Alisa Minkin 5:08

What is that?

Kristin Struble 5:09

we need to back up and say how can we ward off evil spirits by preventing the evolution of these very angry guts? I do talk to moms about their diet and then also with that highly processed foods if we can try to get them to eat more whole foods. Rather than going for the easy stuff like nutrition bars and even, I'm not a big fan of protein shakes, really trying to aim for wholesome food. you read the label, there should be few ingredients and you should be able to pronounce them. I really just encourage drinking lots of water and staying away from more dairy products in general. Then I always recommend to moms to be on a probiotic themself. And then if their babies develop that angry gut reflux colic, I don't care. You can just tell when they're going down that path. I do have one probiotic that I really and found in the last. Several years to seem like it works better than anything. That's made by a company called Claire Labs. I have no affiliation with them We do sell it in our office because it's hard to find and you don't wanna buy supplements on Amazon, and it has to be refrigerated, and it's not like we're making a windfall. It's just, I like the parents to be able to get it on the way out.

Alisa Minkin 6:21

We're gonna say it from the beginning. We're not here to give medical advice. You can mention something, but that doesn't mean that we are advising you. I've used biogaia which I think has been rebranded. Gerber Soothe,

Kristin Struble 6:33

Yep. And

Alisa Minkin 6:33

you know, and El El Rui. El Rui. Strain. That's in Claire. It's it called Claire.

Kristin Struble 6:37

CLA labs. It's K-L-A-I-R-E labs. It's a very common n nutraceutical company. They make pretty good products. It has an, a wide array of seeds that I plant in your, try tell you to

Alisa Minkin 6:51

Interesting.

Kristin Struble 6:51

garden. So it's not just El Rooty, which I think El Rooty, I think biogaia and then Gerber's product, which

Alisa Minkin 6:58

yes.

Kristin Struble 6:58

Gerber bought the

Alisa Minkin 6:59

Took over. Yeah.

Kristin Struble 7:00

And then BIOGAIA has it back on the market. But anyways I like Claire Labs. I think it's a little bit it works a little better. And again, this is based on, this is

Alisa Minkin 7:09

Right,

Kristin Struble 7:10

evidence-based. This is more practice-based the art of medicine.

Alisa Minkin 7:14

Exactly. Everybody, it's not just a science, it's an art. Different doctors will have different, you know, ideas and it's, it's not necessarily right or wrong, so that's really need to be clear about that. I'm not even sure though that it's, it's moms who have more dairy in their diet. I think there's also a genetic predisposition. So if you have another, another sibling with it or the mother had it, you know, I think you need to think about it. And to be clear, when the baby already has Symptoms of that milk protein intolerance, Have to be, you know, the mother has to be completely dairy free. You're not dairy late at that point.

Kristin Struble 7:48

Completely. When you see that at three weeks, I make them go completely dairy free, but from the beginning as I talk to them, I actually say, actually, tell'em about why. Talk to'em about how important it is for their gut health because their gut health is directly impactful. And then if I do have a mom and who has their firstborn did have a pretty bad gut the second child, I definitely will advise them on their diet and say how important it is in the third trimester in particular, to take a probiotic and to really. Try to make certain that they're eating more of a wholesome, clean diet. And then forward when the baby's born, I tell'em to just be dairy free completely. And again, that's based on my recommendations. I've been doing this a long time, and it is, it's, it seems to be working well, but I am not doing my own research. It's more my practice.

Alisa Minkin 8:42

What do you do for soy? Because the soy protein and the dairy protein casein are similar.

Kristin Struble 8:47

that's a really great question. I never recommend soy formula. I never have. But in terms of consuming soy,

Alisa Minkin 8:54

Yeah, that's what I'm talking about.

Kristin Struble 8:55

Yeah, no, I figured, I just wanna make that clear too. But'cause you're right, cows, milk, protein and soy, 75% of kids who actually have an intolerance to Cain, Norway, but casing have an intolerance to soy. Having said that, with moms, I still have them go dairy free and then. I will talk to'em about soy, but I've, I don't want them to completely shut their diet off. I'd rather them focus on the dairy free and then and then look for other, potential causes if a week or two later they're not seeing some level of improvement. And as you probably know, it takes at least two weeks to completely, decrease that those proteins that are triggering it.

Alisa Minkin 9:35

Mother's milk. Right.

Kristin Struble 9:36

Yes.

Alisa Minkin 9:36

we're still talking about a breastfeeding mom. We're gonna need to talk about the formula Fed babies,

Kristin Struble 9:40

correct. Correct. No, yeah. Exactly. But with soy, you had mentioned, you asked

Alisa Minkin 9:44

right?

Kristin Struble 9:45

and soy. I don't necessarily say, know, go off soy too because of the same, association that we see with milk versus soy milk formulas. So Think we have to be careful trying to limit. A ton of other things when

Alisa Minkin 10:01

Right,

Kristin Struble 10:01

that they need to be, providing themself with nutrition as much as possible.'cause One,

Alisa Minkin 10:06

yeah, and I think it's also tricky because we don't have an accurate test to figure out which babies have this milk or milk, soy protein intolerance. It's not an allergy usually.

Kristin Struble 10:18

And in adult medicine and then in pediatric medicine, as time goes on a lot of people like to do the food sensitivity testing and there's still not, a lot of good evidence-based data there. In fact, if you ask an allergist or a GI doctor what they think of food sensitivity testing, not, they, they will poo it, which is fine, but I have to say, I think it's all up. can save your money on the microbiome tests that are out there for even babies poop adults by simply trying to eliminate one thing at a time versus. Removing everything. So back to the point of what moms consume when they're breastfeeding and you know how to improve the situation. I think dairy is, we all know that dairy is the number one trigger. So if you can, then, if we're not seeing much improvement, then you can try to eliminate something else. But that makes sense.

Alisa Minkin 11:10

Yes, but what I'm thinking about is how do you know that? The baby's distress is from the diet. Aren't there other explanations?

Kristin Struble 11:19

Absolutely. There's other explanations, they can be tongue tied. I do think that there's like you had said before, there's a genetic predisposition, but I still think that's gut related because it, to me all disease begins in the gut. So if there's, if you're talking about, I don't know what you were referring to with genetic, but if you're, what were you referring to with

Alisa Minkin 11:41

So what I was thinking about is that it seems to run in families to have this milk protein intolerance. So the mother may have had it, the siblings may have had it, and the mother will come in and say, I started what? You know, the mentum right away.'cause I'm not going through this again.

Kristin Struble 11:55

Okay. Yeah. So you're not saying like there's a, issue or

Alisa Minkin 11:59

No, I don't.

Kristin Struble 12:00

think, I think irritable bowel runs in families

Alisa Minkin 12:03

Mm-hmm. It does.

Kristin Struble 12:04

this irritable bowel in a baby, essentially. That's what I tell my family so they understand what, I'm trying to get to and explain to him. That's not a medical term, but I like to compare it to that. It's irritable, angry bowel baby. Yeah if you're tongue tied, I think that can definitely contribute or be, a cause. But I. I think, it's trial and error unfortunately. I

Alisa Minkin 12:26

That's the bottom line.

Kristin Struble 12:27

And, have them back frequently because they need this, they need support and feel,'cause moms especially, it happens more commonly with First Babies. I'm sure you see that too. And I do think part of that's the energy of being a first time mom, but and that the baby feels that, that mom's nervous because something's going on and the baby's nervous and, and it just, can create some chaos and anyways. But,

Alisa Minkin 12:50

it Definitely a brain gut connection there.

Kristin Struble 12:52

There's definitely a brain gut connection

Alisa Minkin 12:55

And it, it doesn't mean that the baby's not not struggling, and it's not mom's fault. You can say that over and over so hard.

Kristin Struble 13:02

it is so hard and that's where just, that's where just having'em back for follow up if it's possible. Because, it's time consuming. It's hard to get there sometimes for a lot of people. And then it's expensive, to come to see us. But I think that those, it's such an important time to be told you're okay and we're gonna get you through this. And, establishing that, that trust relationship and then seeing the outcomes. It's, I don't know if you're like, it seems like something that is easily not easily, but for the most part we can get them through it. I very rarely refer to gi, the GI doctors when they see my patients, they're like, whoa. Because I try to make all the changes before they get there and then handhold a lot, right? That's what we do a lot in pediatrics is handholds. So I don't know. It's a really beautiful thing to see the ability to help. Really change a gut. So profe profoundly and having mommy be a huge part of that is what a win for her, to be able to be a part of that. And

Alisa Minkin 14:03

And I think having it, you know, high up on your differential to think about this milk protein intolerance is really helpful because I see, you know, sometimes it's missed because they're just saying, oh, it's just colic. Right? And then we have to talk about the formula shuffle for just a minute. That's what I call it. And

Kristin Struble 14:20

yes. And I,

Alisa Minkin 14:21

we're gonna talk about, we've talked about breastfed babies, but we're talking about formula now, and that is best.

Kristin Struble 14:26

yep.

Alisa Minkin 14:27

you feed your baby is best.

Kristin Struble 14:28

yeah. No guilt because, it is, it's, that is really hard on moms, especially nowadays. I feel like there's a lot of guilt thrown out there. And I always tell families that my mother made my, she did, she made my formula with milk and rice cereal and. God only

Alisa Minkin 14:45

Wow.

Kristin Struble 14:45

else. And maybe that explains a lot about me. I'm just kidding. Just kidding. But I would joke with my families, because moms need to know that and hear that as that it's not everybody's gonna choose to breastfeed. My mother didn't. She, back then it was like, for poor people to breastfeed, which is bizarre that anyways. But but she, she did, she made my milk. And nowadays, as, formula's so much better. And it's they're trying to prove it all the time. So Gerber's, all whey protein, it's now Dr. Brown's, it whey protein's easier to digest in my humble opinion. And then, Enfamil I think is the hardest one to digest. And then Similac is a little bit easier. Similacs ready to feed is easier to digest in their powder. Or their similacs ready to feed Elementum. Hydrolite is easier to digest rather than the powder'cause it's or it's potato. The nutramigen is all is casing, but it's hydrolyzed so it's easier to digest.

Alisa Minkin 15:44

So I'm just gonna back up just a little bit and, and make it really clear that for babies who have the milk protein intolerance, we recommend a very broken down formula called a hydrolysate, and that is always Casey, and it's not whey, but it's very, very broken down. I've heard you describe this like brains of sand, and then there are the amino acid formulas because a certain percentage of babies are sensitive even to the small molecules that they're broken down to. And so those are super expensive, like pure Amino and Alpha Amino, and those are the amino acid ones. And at that point I send to a gas too, if nothing else stuck, the prior authorization for these formulas paid for because they're so expensive. But the, I, I was surprised to hear you talk about a a hundred percent the Dr. Now, Dr. Brown used to be good start. Gerber is a hundred percent way, and it's interesting to me because breast milk is 60% way and 40% casen. I always thought that Enfamil would be, would be better tolerated because it's 60% W way and 40% Kian like breast milk and Enfamil. Similac is more tilted towards the Kian, but I've also heard parents say the same thing. So.

Kristin Struble 17:00

Your explanation was perfect, and thank you for backing up and clarifying Whe protein is far easier to digest than casing.

Alisa Minkin 17:07

Talk about way versus Casey and, and why Casey and his heart to digest.

Kristin Struble 17:12

As it's, it is the source of cow's, milk, protein allergy or intolerance. It's not the way that is, and it's just the different molecular structure.. But there's many other things in the formulas that can be problematic for the gut too. maltodextrin, which is a common substitute for the corn syrup, solids in the regular US formulas is still irritating to the gut. Many components, but casein is the number one trigger, which is why I think if moms take dairy out of their diet completely and. You have to clarify that with moms too, by the way. It's not the butter.'cause there's no

Alisa Minkin 17:48

Right.

Kristin Struble 17:49

in butter. It's the, and it's not the milk sugar.'cause a lot of moms will be like I'm on fair life now. It took the lactose out. It's the protein and it's the casing and the protein. You can have an intolerance to weigh, but it's, more the casing that's the problem. Did I

Alisa Minkin 18:06

I don't believe you can use, I don't believe you can use the Dr. Brown a hundred percent WHE formula for babies who have milk protein intolerance.

Kristin Struble 18:14

No. You cannot. You can't. So you can't.

Alisa Minkin 18:18

It's a spectrum, though I will say it is on a spectrum, and especially because we don't have a test. Do you do guac for microscopic blood testing for your babies? So I've done it too, but it's not recommended. I just looked up the current recommendations and they're to, to just, if you have a baby that you suspect. Has the milk protein intolerance to either of the mother's breastfeeding to start her on a dairy-free diet, or the baby to put them on a hydrolysate, give them, they want you to do a two week trial on, and then they want you to take them off it. I have never, ever done that. I can't imagine doing that to a mother. That to me is not practical To prove that that's what it is.

Kristin Struble 18:53

Obviously, if it's bright red blood, there's blood in it. But I don't chronically do it, but I'll do it. I'll do it once or twice to confirm it. And what I'm looking at is those babies are typically fussy. So if they have blood in their stool, they're very fussy. If obviously we would be if they have mucus and the and or the poop is green. I test it. And they're fussy. So my goal would be that, yeah, I would love if the actual, if the microscopic or the macroscopic poop or the macroscopic blood disappeared because, but more importantly, how are they acting a week later? How are they acting two weeks later? That's really the critical component because even if I see blood in the stool via the guac two weeks later, I'm not gonna stop the baby. I'm not gonna tell the mother to stop the breastfeeding. I'm just not I'm gonna figure out other things like there was there's a doctor in our office who had it continually happening despite taking dairy out. Then she took corn out and it finally disappeared. But it took a long time for that to be the case. And her daughter was fussy, but not terribly fussy. So anyways I still think that I still think there's some value in bio testing but I don't think it needs to. Dictate the the outcome necessarily.

Alisa Minkin 20:09

Right, right. What I was reading is that it can be positive, but the baby may not have milk protein for various reasons, or it can be negative, and I've definitely seen that where the baby does have it. And the bottom line is, like you said before, it's trial and error. I wish we had a better way. It's really just trying, you know, different formulas or, you know, the mother's diet. But you don't, I'd be concerned about trying to limit the mother's diet with a million different things. I mean,

Kristin Struble 20:36

I

Alisa Minkin 20:37

that's, that's problematic. More problematic than trying different formulas.

Kristin Struble 20:41

You know

Alisa Minkin 20:41

Hmm.

Kristin Struble 20:41

interesting to me about this very concept though so let's say the baby also has eczema, which there is a skin gut connection for sure. That's absolutely that. If the baby has severe eczema at four months of age, I know you know this, you send them to the allergist, right? The allergist can literally determine. Via the tests, what mom needs to take out of her diet in order for the eczema to improve, and then also to know, of course, what the baby's gonna potentially be allergic to when they start solids. But it is crazy to me to see the profound impact on their skin when the doctor actually figures out, when the allergist figures out what's in mom's diet that's triggering it. Like I just, super cool to me. But

Alisa Minkin 21:24

And I wanna really, I wanna really make it clear that there's a difference between allergic disease, which is mediated through the IgE pathway and the milk. Sometimes soy protein intolerance, which is not mediated that way. It's not an allergy. It's more of an insensitivity, more of a sensitivity. And it's often outgrown. And allergies may be outgrown, but but are less likely to be outgrown. And what you're seeing. With eczema is more likely to be a true allergy and, and that's different.

Kristin Struble 21:53

Y Yeah, I would agree with that. Absolutely. Obviously'cause that's scientific, but it all too seems in pattern recognition that the kids who have seia also have reflux, irritable bowel, all these things. So there's gotta be some sort of connection there. Is your outcome gonna be to develop, cows milk, protein allergy versus sensitivity? Who the heck knows that's gonna continue to evolve over time? I think too, in terms of having more evidence-based data to support it. And I think it'll all be, it'll be whittled down to the diversity of the gut microbiome to see, exactly what bacteria might. Be missing or not as diverse in the gut? I don't know. There's a lot to be learned, but at this point, what we have is an elimination diet process or changing the formula or being proactive and having mommies, really just be careful with their diet in general. So

Alisa Minkin 22:56

right. It reminds me of the story of somebody's drinking a cup of whatever, and they're saying take the spoon out. It's hurting your eye. Take the spoon out. Like if the formula is causing a problem, change it. If the mother's diet is causing a problem, change it. And don't overthink it. And, you know, we're learning so many things and it's so exciting, but there's so much more we don't know.

Kristin Struble 23:14

So much more. We don't know. And I, but I think it's exciting times with where we are now versus where we were 10 years ago with the

Alisa Minkin 23:21

Right

Kristin Struble 23:24

it's just crazy how it's, there's just so many institutions after the newest, data and, research on this very subject. You see it in Medscape talking about how there's a link with psoriasis in the gut and schizophrenia in the gut, and just all these, an asthma in the gut and antibiotics and how it can, trigger IBD in the future, or there's an association. It's, I think we're definitely on the forefront of not only knowing how to prevent the diseases, but how to treat them based on the, on what's in the poop.

Alisa Minkin 24:00

right. And I'm thinking again about eczema and it. We talked a little bit about having a true IgE mediated allergy. We're sending them for testing, but lots of eczema is not associated Right. With

Kristin Struble 24:15

Oh

Alisa Minkin 24:15

an allergic trigger, but it's still inflammation. Right. And so I wonder if that's what you're seeing connect to the non-allergic sensitivities,

Kristin Struble 24:24

correct.

Alisa Minkin 24:25

going on? Just

Kristin Struble 24:27

I think that there's still, that whole leaky what the leaky gut

Alisa Minkin 24:31

mm-hmm. You can tell my listeners though.

Kristin Struble 24:33

yeah, it just, essentially, it means when you have chronic inflammation in the gut, it triggers leakiness and so it allows those proteins into the bloodstream and then the body thinks that it's, those are foreign invaders and creates antibodies against them. I think that inflammation is inflammation and if it's there, it's, gonna potentially trigger cradle cap and eczema and reflux and all these things we see in, in little ones. And then if they have reflux and I know that there's an increased potential for ear infections and, and if your gut's also You're more likely to have chronic congestion, and if you get a cold, you're gonna end up with those ear infections. So it's all, I think it all really stems from the gut. Trying to find a beautiful balance of the garden and the gut early on is critical. And I do think that starts with mommy's diet and breastfeeding, or making sure that the formula the baby's on is being digested. Because if it is, then whether or not it has palm oil or, any of the other things that are talked about right now in the media if it's being digested. I think the gut is much more it's not leaky. It's much more diversified. The microbiome is more like a protective barrier like it's supposed to be, rather than. Leaky and open with lots of channels, allowing things that shouldn't be getting through to get through, and that's like a huge, that's the foundation of functional medicine, is that very concept, which, as that's what I love,

Alisa Minkin 26:04

yes, and I, and I agree. It's really, really important and I just feel so much for parents nowadays because as I told you before we started, I did a rabbit holding on formula and oh my gosh, there's so many different brands with so many different clean. This one has that, but has this, and you know, like you mentioned the palm oil. It's a thing to try to avoid that. And, but it's in this formula that's not good for other things. It's just work with your pediatrician and if your baby is thriving, don't stress it because there are so many good say formulas and if it's working for your baby. I, I, I personally would not, I wouldn't change it and I wouldn't, I wouldn't go rabbit holing obsessively researching because you could go crazy. I mean, I'm not a new mom and I was going crazy.

Kristin Struble 26:51

Yeah, and you can also trigger their gut to be unhappy if you change them from a formula. To your point, that is working well, you freak out that it has corn syrup, solids or palm oil or whatever, and you put the it literally if they're digesting it well, don't change the formula if it's there is, I feel bad for families that are, on Instagram that are constantly inundated with this stuff. So it's confusing.

Alisa Minkin 27:18

And what about baby constipation?'cause we talked a lot about milk protein intolerance, but baby constipation is something we see a lot of too. And we'll say constipation. A lot of times we might not call it constipation. So I'll let you go there.

Kristin Struble 27:31

I would say. a baby is constipated, they're not. It just, I wrote a children's book about poop, right? How to be a poop detective. It starts when the baby's born. Everybody that's focused on the baby's poop from day one. And if a baby develops constipation, it means the formula's not being digested. I think it's pretty unusual for baby should not be constipated at all. So if you have one that's constipated, there's ea either a neurologic issue with the gut, rungs can be developing. Because that point their poop should be liquid. Or CD or all, but if they are constipated, they are absolutely, I'm sure, fussy as heck. And so you would change the formula. So I, and I you asked me which one to change it to, I would. If you're gonna do a regular formula that's not hydrolyzed, then I would do Dr. Brown's. That used to be good start.'cause it's white protein only. That would be my

Alisa Minkin 28:27

Right, right. And I, I was thinking of little Miss Muffets had in Hert and eating her kds in whe Right. It's the casing that clumps into kds. And I believe could be related to the constipation, but, but first we forgot to define what is constipation. I was alluding to it before, very subtly, Where a parent will say, my kid's constipated. They haven't pooped in 48 hours.

Kristin Struble 28:49

Yep. That's a very good point because obviously you, and I know if they're breastfed, can go many days without a bowel movement and then have those puns. But if

Alisa Minkin 28:58

Pun.

Kristin Struble 28:59

hard, they have really hard poops, they're straining to actually go the, they're having, they're tearing their developing fissures from tearing through their anus, then that's a problem that shouldn't be happening. But if they're

Alisa Minkin 29:12

Right,

Kristin Struble 29:13

you know,

Alisa Minkin 29:14

right. And

Kristin Struble 29:15

it's

Alisa Minkin 29:15

right.

Kristin Struble 29:16

with a gross spurt.

Alisa Minkin 29:17

Right. And, and, and sometimes, especially with the more broken down formulas, it's similar to breast milk where they don't poop right away. So constipation is defined by a To pass stool, not a liquid stool that, you know, just took longer to come out before the PMI stage. I, I'm still in that one.

Kristin Struble 29:33

I like to use terms that are like, our three year olds and our five year olds, I'm just

Alisa Minkin 29:38

Oh no. Pediatricians can talk about poop all day,

Kristin Struble 29:41

I,

Alisa Minkin 29:41

but we weren't supposed to talk so much about it. So I'm gonna move on. I promised you I wanna talk about feeding older babies. Do you recommend a probiotic for all kids?

Kristin Struble 29:51

Not necessarily, no. I only recommend it if they have gut issues to begin with or down the line if they have gut issues. So if they come in with abdominal pain and any complaints or any suggestion that their gut's off, then I will have them put, go on it. And absolutely. If they are on an antibiotic, I always put them on Florastor, which is Croce it's yeast. So it's non-pathogenic yeas. It protects the gut. It's the only one with data, showing that it supports the gut while you're on an antibiotic. So I actually take it every day. It's great for IBS too

Alisa Minkin 30:24

Flora Store Is a brand name for that

Kristin Struble 30:26

f-L-O-R-A-S-T-O-R

Alisa Minkin 30:30

Flora Store.

Kristin Struble 30:31

the best price.

Alisa Minkin 30:32

Yeah.

Kristin Struble 30:32

and it comes for kids there's a baby one, and then there's a kid one that's a packet and you can mix it in water or there's just the adult capsules. But it, I'm religious about it when patients are on antibiotics and

Alisa Minkin 30:46

Yes.

Kristin Struble 30:47

huge.

Alisa Minkin 30:48

Yeah,

Kristin Struble 30:49

If I have patients who have diarrhea of any sort, I have'em start on it right away.

Alisa Minkin 30:52

So let's talk about feeding a baby. We're talking about weaning to solids now. What are some of your tips and tricks for that?

Kristin Struble 31:03

I don't know if your recommendations have changed over time, but I still am a fan of starting out with Pure, I know that's like kind of the. Go against the grain. Right now everybody's really into solid starts any

Alisa Minkin 31:18

Yeah.

Kristin Struble 31:18

lead weaning. And I, I just, for me, I still think it's good to introduce a sour salt, sweet and savory to the palette and purees first, and then build on the purees a little bit of texture. And then if you wanna start introducing more of the, the baby-led weaning, that's fine. But I think solid starts is a great app, and I don't know if you follow them,

Alisa Minkin 31:41

Mm-hmm.

Kristin Struble 31:41

they're all evidence-based and they do a great job. But always say that. To families to exercise caution, no one's the expert CPR training's. Not a bad idea, all that stuff. But the biggest message would be one that I'm sure you agree with, which is avoid highly processed foods, avoid the snack foods, avoid the, know, I would say even Cheerios, cereals in general that are, we used to recommend pinch or grasp and, working on that, early on in, in my career. But I think the more we can avoid kind of them to the highly processed I think the better because I think it does start early. But anyways,

Alisa Minkin 32:21

And it could be a moderation too.

Kristin Struble 32:22

correct

Alisa Minkin 32:23

hate for parents not to give the kids a chance to do that Penta grass'cause that's a very important fine motor skill.

Kristin Struble 32:28

It

Alisa Minkin 32:28

But also, I thought you were gonna say choking hazards. Watch out for choking hazards, please. For years.

Kristin Struble 32:33

which is why I love solid starts because as you probably know they show you exactly how to cut up the food at each. So it was to, to avoid the potential for choking. Obviously there's always still gonna be the potential, but that's one of the reasons I really what they do. But I do feel like it's really important also to push the message.'cause I hear this a lot. I was told that between six months and a year of the solids that I'm giving my baby aren't really for calories necessarily. It's more to introduce them. I don't agree with that. I think our whole goal is to try to increase the amount of calories and decrease the amount of liquid calories or the solid calories over time and decrease the amount of liquid calories between six months and a year. I don't think it's just for fun first,

Alisa Minkin 33:18

before one is just for fun. You don't agree? Yeah.

Kristin Struble 33:20

no, I think because my goal is I want them to be eating their calories like humans should by the time they're a year. I think the vast majority of what the calorie source should be is from food not from. What we're drinking, but from what we're eating,

Alisa Minkin 33:37

you know what I, I, I, first of all, I like a combination of, of baby led weaning and purees. And I will tell you every baby is different. I'm watching my two youngest grandchildren learn to eat, and they are the opposite, you know, one.

Kristin Struble 33:50

awesome.

Alisa Minkin 33:51

One is really loves to eat. Went right from purees to, you know, regular food. I was actually watching a seven month old baby at a wedding the night eating like actual, like chicken didn't have teeth. You know, so some babies are really great eaters, you know, and then, you know, my, my, one of my other grandkids likes to taste things and experiment and play. But we keep saying food before one is just for fun because it all ends up on the floor. But I, I, I wanna remove, I wanna remove the anxiety that, you know, you're not doing it right like that today. Parenting is like a, an Olympic sport. It is just insane the amounts of pressure. And I really, I want that to stop. There's such a wide range of normal if your baby is growing and gaining, you know, that is the main thing. The only thing is though, that sometimes what happens is, and I see this more with the, with the, with the bottle fed babies, that they don't get a chance to be hungry. Because they're on the bottle, and then the next thing you know, they're one and they're drinking 40 ounces of milk a day, and then they go to cow's milk. So you have to talk about cow's milk

Kristin Struble 34:59

I, to I actually love your point, which is why think that it is important to have that conversation of the seesaw because if they are not decreasing the amount of the formula, they're never going to eat more. They're, they,

Alisa Minkin 35:12

right?

Kristin Struble 35:12

when they're hungry in full. So I always talk to'em, at nine months, I really want you to decrease the amount of formula. Two, like 15 to 20 ounces. Even

Alisa Minkin 35:22

Right,

Kristin Struble 35:23

the can says 28 to 32,

Alisa Minkin 35:25

right.

Kristin Struble 35:25

focus on giving your kids solid foods in between now and a year. So in a month, I want you to decrease the bottle and so on and so forth so that by the time they're a year, they're actually off it completely. So that's when I say go to water, I, as I'm not a cow's milk for kids fan. I don't believe kids should be drinking calories. I think they at a year. personally think, and this is not trying to guilt, shame or tell anybody they're wrong if they disagree with me, but I think kids should drink water and eat their calories, so they wanna have cow's milk here and there, or anything to drink for fun later down the line, that's fine. But I that's wholeheartedly what I believe to be the most sound decision.

Alisa Minkin 36:06

I, I do exactly the same thing as you, except for I don't say no milk. I'm not as extreme as you on that, but, but I, but I see your point, and I quote Fki, who I've heard you talk about, or I didn't realize how anti milk he was. I just quote his line of cows milk is for baby cows.

Kristin Struble 36:23

Yep.

Alisa Minkin 36:23

Because I see, you know, such an overload of cow's milk when they go to it, and they're used to having their diet be primarily milk. And so I also start at nine months and say, you know, I want no more than, you know, 16 to 20 ounces of formula because I, you cannot have more than 16 to 20 ounces of cow's milk. That's what I say, that that is the outer limit. But I also say, no milk fine with me.

Kristin Struble 36:45

Yeah, for sure. No, that's it's it's actually think bottom line is we all, the beauty in medicine too, is, we're all gonna have a little

Alisa Minkin 36:55

Mm-hmm.

Kristin Struble 36:56

viewpoints. We all have our hard, firm foundations of medicine, like vaccines and, obviously, pool fences and things that we all agree with, but but that's the beauty of it.

Alisa Minkin 37:07

We're talking, we're talking about cow's milk, and we, we don't have exactly the same viewpoint, but we do align pretty closely.

Kristin Struble 37:15

Oh,

Alisa Minkin 37:15

I, I don't know. I don't know that our research is so clear about, say, dangers of cow's milk, but we don't need cow's milk. I like how a gastroenterologist I know says this, all a beverage. It's just a beverage and water is the best beverage,

Kristin Struble 37:31

well

Alisa Minkin 37:31

but.

Kristin Struble 37:32

that

Alisa Minkin 37:33

But some kids really don't eat, and it's, it's really a problem. We're we, we need to take just a minute to talk about kids who did not transition to food. And I'm seeing kids who may be neurodivergent, but sometimes they're not. They don't have any particular issue. They just haven't made it to transition to solids. I don't know if you're seeing that.

Kristin Struble 37:57

Here's the one thing that, that we know is that cow's milk is one of the more common causes of anemia in toddlers. Even Dr. Oskie talks about that in his book. I think anything that can, and it's not because they're over consuming it, so they're not getting calories from other sources, that's always a possibility. It's because it causes micro bleeding in the gut and it blocks the absorption of iron. To me, if there's something that can do that, I think that should be a very big red flag, that it shouldn't be consumed. And there's a big difference between cow's milk itself and dairy products. Dairy products, because they're either fermented or broken down, they're much easier to digest. Why I am like extremely passionate about it. And the number of kids that come into the office with chronic abdominal pain and constipation and are put on MiraLax. Yeah, MiraLax is gonna help. But you have to go upstream and say why, and

Alisa Minkin 38:47

Okay,

Kristin Struble 38:47

milk is probably

Alisa Minkin 38:49

constipating.

Kristin Struble 38:50

common. Yeah. So to me it's always a signal that if your poop is off, it's a grade of what you're consuming. So you have to look at your diet and say, Hey, is there something that I'm consuming that might be causing my IBS, my constipation, my vitiligo, my, psoriasis, my, acne, whatever. To me, again, if there's something that can cause anemia, we also have to ask what other things could it be causing? What other tr because it's inflammation in the gut, right? All disease begins in the gut. Inflammation is the trigger.

Alisa Minkin 39:23

Yeah.

Kristin Struble 39:23

One of my favorite gastroenterologists actually talked to me about and she's somebody who endorsed my book. She said that there's, and you know this probably too, I keep saying this'cause you are very well read the case Morphine breakdown of there's actually, an opioid stuck to the Cain molecule. The idea is that it's supposed to addict the baby to the mother's milk. When babies are switched over to cow's milk, it's somewhat addictive. And so that, she actually talked about that, and I thought that was interesting. So anyways, you can fact check me on that one, but

Alisa Minkin 39:55

Yeah, but I, I, I'm, I'm, I'm an, yeah, I'm an autism mom and so there was a whole gluten, casein-free diet. And you haven't started talking about gluten yet, but I wanna really be careful here because parents are anxious enough and a lot of kids are on that beige diet and you're just trying to make it healthy. Or

Kristin Struble 40:15

Correct.

Alisa Minkin 40:15

want parents to go, oh my god, milk is inflammatory. I've gotta get my kid a hundred percent off milk. First of all, again, we're not here for medical advice. Talk to your pediatrician, number one, And number two, it really depends. There are some kids who totally can't tolerate it and it can make all the difference in the world. And there are some that are just less, would be more. I try to get the less is more. That's what I work on.

Kristin Struble 40:36

And that's such a reasonable thought process. I would have to say to you that to me that it, it is really important to not make moms feel guilty. And

Alisa Minkin 40:45

Yeah,

Kristin Struble 40:45

me, I wasn't a perfect mom. I'm still not a perfect mom. You

Alisa Minkin 40:49

there's no such thing. There's no such animal.

Kristin Struble 40:51

no. And I always said, my kid will never eat hot dogs. My kid will never eat Chick-fil-A. My kid will eat salmon every day. My kid will do this and that horrifying line, and, really judgmental. And you're, until you are the parent of a toddler, you are the parent of a five-year-old and so the most important thing to do is love your child, but to your point, try to make it healthier. Try to like, make little substitutions here and there that might make a big impact. So yeah, we have to give ourself grace, but then if there are certain things we can do just substitutions with the realistic, meet people where they are of approach, I think makes sense.

Alisa Minkin 41:32

Yeah, you know, I was starting to talk a while back about kids having trouble transitioning to solids. I see a lot of that and we actually have a occupational therapist who specializes in feeding issues, come to our practice once a week, and she works. She's also a lactation consultant, so she works with the new moms with, with the breastfeeding, but she also helps these moms, help these kids who are struggling to transition. I'm not sure what's going on, but I will say that trying to, you know, start solids in a way that is. Not anxiety provoking for the child or the mother starting in that window when they're ready, you know, between four and six months and not, not waiting too long and not getting stuck on the purees. The problem with the puree approach, right, is I, I see some parents, I don't know if they're worried about choking or they just don't want the messiness of the baby feeding themself, and these kids end up struggling to move beyond the purees. It may be because there's so many pouches out there, I don't know what it is. Are, are you seeing this or is it just

Kristin Struble 42:39

I have theories about it. I think that the kids, if you want me to share my theories, but I think

Alisa Minkin 42:44

Yes.

Kristin Struble 42:45

who have more refluxy, angry guts that probably have either silent reflux or real reflux are always gonna have more of an oral aversion situation.

Alisa Minkin 42:56

Interesting. That's true. For sure.

Kristin Struble 42:59

feeling like they're gonna, so these kids in fast forward, who have these feeding issues then require somebody to almost do trauma therapy with them to help them

Alisa Minkin 43:10

Mm-hmm.

Kristin Struble 43:11

the texture issues, right?

Alisa Minkin 43:12

Right

Kristin Struble 43:13

oftentimes those kids have big tonsils. They have from the silent reflux,

Alisa Minkin 43:17

right,

Kristin Struble 43:18

they've

Alisa Minkin 43:18

right.

Kristin Struble 43:19

of ear infections and multiple antibiotics and yada. Yeah.

Alisa Minkin 43:22

There's, there's definitely kids with feeding disorders and, and my daughter had one of the worst ones I've ever seen. She had all those things, the tonsils, the reflux, everything, and wasn't able to eat food for four years. It's very unusual. This is my autistic daughter, so,

Kristin Struble 43:37

she the,

Alisa Minkin 43:38

yeah. Yeah. So with an autism, you can see such severe, severe, and I recommend a, you know, getting services through early intervention or, you know preschool services, school age services, whatever. They'll often cover it. The younger you are

Kristin Struble 43:53

was

Alisa Minkin 43:54

feeding therapists, gastroenterologists, all those people get a team approach.'cause that's, that's a feeding disorder. That was actually not what I was talking about earlier. I wasn't talking about feeding aversions or feeding disorders. I was talking about just kids who didn't learn how to eat.

Kristin Struble 44:08

I wonder though if I do feel like there's oftentimes a very strong correlation though with kids who are neurodivergent. Or have sensory issues, not necessarily, the spectrum

Alisa Minkin 44:19

Mm-hmm.

Kristin Struble 44:19

if you

Alisa Minkin 44:19

Mm-hmm. And gut things too. They, they often have gut things.

Kristin Struble 44:23

And when they're babies, I find that there's definitely, was your daughter easy? Was she like your easiest child or was

Alisa Minkin 44:30

No.

Kristin Struble 44:30

as an infant? Was she spitty, colicky, fussy?

Alisa Minkin 44:33

the things. Yeah.

Kristin Struble 44:35

so that's where I do feel like it starts the beginning. I think not again, I just, I feel like this space is so awesome and exciting because I think we're just gonna continue to build on what we know and anyways, so

Alisa Minkin 44:49

No, it's, it's true. We, we knew less, this is, you know, over 30 years ago, so we knew less than, than we know now. But it's still, it still can be really, really hard. I've seen, you know, children on the spectrum get scurvy.

Kristin Struble 45:02

Yeah.

Alisa Minkin 45:02

one had to get a a a G-tube, you know, You know, a tube fed because they, they absolutely couldn't eat. So that's the most severe end. And these are often kids who do, you know, have the beige diet very limited or drinking a lot of their calories. So that's, that's where, you know, I, I think starting early is best and getting the help you need. Building that team is really important if you're in the feeding disorder world. But I am concerned about overuse of those pouches.

Kristin Struble 45:28

I But I also don't want to judge moms either.

Alisa Minkin 45:31

right? It's weird.

Kristin Struble 45:32

mom feel badly because they're using the pouches, but I do, it's just like thinking about, like, how can we make little changes? That one I would use as a last resort,

Alisa Minkin 45:42

Almost done. I wanna talk for a few more minutes about diet and mood and behavior, because we didn't yet discuss that. I actually had someone ask me recently what probiotic is best for a child with anxiety? And I was so surprised by that question because I wouldn't think that that would be how you would use a probiotic. Have you ever used probiotics for, for mood?

Kristin Struble 46:09

I would say it would be part of the equation. Yes. It's not

Alisa Minkin 46:13

Mm.

Kristin Struble 46:15

the, obviously you're gonna treat everything, but I think it's all about rebalancing the gut. And that's not just with a probiotic, that's with just, again, doing a food diary and saying, Hey, are there's little changes that we can make to maybe modify your gut a little bit. And then if you can get them to take a, an Omega-3 and, a multivitamin. Also ask them about other lifestyle. How's sleep, what's going on? An hour before bed, what's the bedroom look like? Know, are your child getting exercise? Are, tell me about devices. Me about are we socializing? Are we getting out in nature? So would I say that probiotics going to, help treat anxiety? No, but it is definitely something that I would consider as part of the the process in terms of healing. So

Alisa Minkin 47:03

Right, and you don't have a specific probiotic for that. It would just be probably florist or For a kid like,

Kristin Struble 47:09

yeah I would do Flora Store for sure. That would be my favorite go-to. And. Omega threes. I think trying to find one that the child will take, because the majority of the time the, the taste is the issue. And that's within even a multivitamin. So it's trying to find one that a kid has, sensory issues, doesn't like the, the crunchiness of it or the flavor of it, or they don't like gummies and not the gummies are necessarily always great, but the key is getting them to take a multivitamin. A probiotic, and an Omega-3. And I also will use magnesium too. I do think that magnesium plays a part in it too

Alisa Minkin 47:48

especially with constipation.

Kristin Struble 47:49

Yep. Absolutely.

Alisa Minkin 47:51

I love that you, you pre-answered my question on supplements, but I wanna say something about supplements is, I don't know if you have a special, you know, a place you recommend, but it's, you have to be so careful because unlike medication, it's not FDA regulated. And you know, if I was checked for like third party testing, stuff like that, so that you're getting actually hopefully what you pay for.

Kristin Struble 48:11

Yeah, I absolutely have to agree with you there. You can go down the rabbit hole of supplements. I've seen it, even in my journey when I first got into functional medicine, I was so excited to have all the names of all the different companies, and I do have favorites and whatnot. But what I realized is, if you put people on too many supplements, you're gonna, you can mess up their gut. It's and you have to be so very careful about where you're getting them from. Not do not buy supplements on Amazon. You get them from the manufacturer or full scripts, which is like a Walgreens for for multivitamins and for supplements. But none of this stuff is really. Monitored by the FDA, like it should be. So yeah, third party testing is really important. It's the wild west. And the other thing about that is is all the testing being done. When I first got into functional medicine, I was so excited about doing all of the poop testing and the sensitivity, food sensitivity testing. And there's so much out there with that now, and I really caution people on that too, because it's expensive. I think you're gonna get bang for your buck just sitting down with your pediatrician or your provider and going for your lifestyle and your timeline and trying to figure out, if there are things that you can do to all the things I talked about, sleep, exercise, socializing, circuit, that actually all affects your gut if it's right,

Alisa Minkin 49:39

Million percent

Kristin Struble 49:40

it's it's, it goes back to the basics of what we know in, in looking at. Diet and lifestyle and saying, how can we help people move forward without expensive tests? And all these

Alisa Minkin 49:51

right. This, this is.

Kristin Struble 49:52

some of it, but

Alisa Minkin 49:54

Yes, this is true holistic medicine, and I agree with you a million percent, and I really, we could, we could just keep going on and on and on. I wanna stop right here though. Thank you so, so much for doing this. And I think we're gonna have to do part two because there's more things we didn't get to talk about.

Kristin Struble 50:11

I know Part 10 will be,

Alisa Minkin 50:13

We didn't even talk about sugar in kids. Somebody asked recently about is it true that sugar causes hyperactivity or causes mood problems? We didn't even get to that,

Kristin Struble 50:23

we'll get to that.

Alisa Minkin 50:24

But,

Kristin Struble 50:25

two.'cause that

Alisa Minkin 50:25

but I,

Kristin Struble 50:26

one.

Alisa Minkin 50:27

yeah, but a too long didn't do, don't read, didn't read or didn't listen. Would be, it's, it's not that simple, you know, like, listen, limiting sugar is great. Can you, you know, if you can do it. But going back to those basics,

Kristin Struble 50:41

Yep,

Alisa Minkin 50:41

it's just. Someone once said, or maybe I said it, I don't remember. I'll take credit. That sleep diet and exercise of the Holy Trinity.

Kristin Struble 50:50

I love it. No, that's true. But at the same time, if your kid has sour patch kids and goes trick or treating and chocolate milk has a, like all, it's what happened to moderation and everything. Like my mother said that. You said that the hard part is it's there, that's a whole nother topic too. Why but

Alisa Minkin 51:08

Yeah, but small changes and, and don't judge your kid. Don't change, judge yourself. Life is too hard as it is for us. We gotta, we gotta give ourselves grace. Thank you so, so much. I really appreciate it. I'll have to come back for part two.

Kristin Struble 51:20

Yeah, exactly. Have a really good rest of your

Alisa Minkin 51:22

You too.

Kristin Struble 51:23

me.

51:29

Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.